Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1984
Randomized Controlled Trial Comparative Study Clinical TrialVasoconstrictors in spinal anesthesia with tetracaine--a comparison of epinephrine and phenylephrine.
A randomized double-blind study was conducted in 50 orthopedic patients to determine the effect of epinephrine and phenylephrine on the anesthetic properties of intrathecally administered tetracaine. Two doses of each vasoconstrictor agent were studied: 0.2 mg of epinephrine, 0.3 mg of epinephrine, 1 mg of phenylephrine, and 2 mg of phenylephrine. The results show that both vasoconstrictor agents in the doses used significantly prolong duration of sensory anesthesia and motor blockade produced by the subarachnoid administration of tetracaine. At equipotent doses no differences existed between the ability of epinephrine and phenylephrine to prolong the duration of spinal anesthesia produced by tetracaine.
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Vecuronium bromide, 0.045 mg X kg-1, was compared with pancuronium, 0.07 mg X kg-1, when used to provide muscle relaxation for tracheal intubation and abdominal relaxation for outpatient gynecologic laparoscopy. Both drugs provided adequate intubating conditions within 5 min and satisfactory abdominal relaxation. Because spontaneous recovery from vecuronium was more rapid, either with inhalational or nitrous oxide-narcotic techniques, pharmacological reversal with edrophonium and atropine was either not necessary or more easily accomplished after vecuronium, as shown by the train-of-four. ⋯ Tests of muscle power and coordination performed 30 and 60 min postoperatively showed no difference between the drugs. There were no postoperative complications related to muscle relaxants and all patients met our discharge criteria the day of surgery. Given the conditions observed at the end of the procedure, we would choose vecuronium for muscular relaxation in laparoscopic surgery.
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Anesthesia and analgesia · Jan 1984
The effect of fentanyl on arginine vasopressin and cortisol secretion during anesthesia.
The effects of nitrous oxide-oxygen plus small doses of fentanyl with (N = 7) and without (N = 15) naloxone and the effects of nitrous oxide-oxygen plus halothane (N = 13) on plasma concentration of arginine vasopressin (AVP) and cortisol were studied in normal patients before and during gynecologic laparotomies. Patients given fentanyl alone received incremental doses of 0.002 mg/kg before, during, and after induction of anesthesia. Naloxone, when given, was injected in doses of 0.005 mg/kg before administration of fentanyl. ⋯ There were comparable increases in AVP and cortisol levels in both groups during surgery. Administration of naloxone before fentanyl prevented the increase of plasma AVP levels during anesthesia and surgery and blunted the elevation of plasma cortisol during surgery. Our results suggest that the increase in plasma AVP levels after induction of fentanyl anesthesia may not be induced by the stress of intubation and that small doses of fentanyl may cause AVP release during anesthesia.